Attachment styles are used to describe patterns of attachment in relationships. Adults with a secure attachment style tend to have good self-esteem, they share their feelings with partners and friends, and have trusting, lasting relationships. Insecure attachment styles include anxious attachment style (also known as ambivalent or preoccupied), which involves reluctance to become close to others, worry about the security of relationships, a reduced sense of autonomy, and increased dependence on others. Avoidant attachment style is another insecure style. It involves problems with intimacy, over-regulation of emotions, and unwillingness to share thoughts and feelings. Fearful attachment style is represented by an inconsistent sense of self and an inability to regulate one’s emotions.

While attachment style in adulthood is thought to be based on early experiences with primary care givers, life’s experiences can also impact on attachment style in adults. Children described as ambivalent or avoidant can become securely attached as adults, while those with a secure attachment in childhood can show insecure attachment patterns in adulthood.

What is the evidence for attachment styles in people with bipolar disorder?

Moderate to high quality evidence finds a large effect of more insecure attachment styles in people with bipolar disorder compared to controls. This effect was similar to that seen in people with depression or schizophrenia. It was also similar across all three disorders for anxious attachment style. However, for avoidant attachment style, it was small for schizophrenia, medium-sized for bipolar disorder, and large for depression.

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Attachment styles are used to describe patterns of attachment in relationships. Adults with a secure attachment style tend to have good self-esteem, they share their feelings with partners and friends, and have trusting, lasting relationships. Insecure attachment styles include anxious attachment style (also known as ambivalent or preoccupied), which involves reluctance to become close to others, worry about the security of relationships, a reduced sense of autonomy, and increased dependence on others. Avoidant attachment style is another insecure style. It involves problems with intimacy, over-regulation of emotions, and unwillingness to share thoughts and feelings. Fearful attachment style is represented by an inconsistent sense of self and an inability to regulate one’s emotions.

While attachment style in adulthood is thought to be based on early experiences with primary care givers, life’s experiences can also impact on attachment style in adults. Children described as ambivalent or avoidant can become securely attached as adults, while those with a secure attachment in childhood can show insecure attachment patterns in adulthood.

What is the evidence for attachment styles in people with schizophrenia?

Moderate to high quality evidence found the prevalence of insecure attachment styles is higher in people with schizophrenia than in people without a mental illness (76% vs. 38%), with fearful attachment style being the most prevalent in patients (38%) followed by avoidant (23%), then anxious (17%) attachment style. This large effect of more insecure attachment styles in people with schizophrenia compared to controls was similar to that seen in people with depression or bipolar disorder. It was also similar across all three disorders for anxious attachment style. However, for avoidant attachment style, it was small for schizophrenia, medium-sized for bipolar disorder, and large for depression.

Small to medium-sized associations were found between increased general and positive symptoms and increased anxious and avoidant attachment styles. There was a weak association between increased negative symptoms and increased avoidant attachment style, and no significant association between negative symptoms and anxious attachment style. There were also medium-sized associations between decreased social and personal recovery and increased anxious and avoidant attachment styles in patients.

February 2022

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